Asthma is a condition that manifests with wheezing, usually on expiration, and is related to constriction of the bronchioles, or small air tubes, leading into the air sacs of the lungs. Typically asthma is found in persons with allergies. The allergen, or substance to which the person is allergic, reacts in the body to produce antibodies belonging to the IgE subgroup. When the allergen and antibody meet, they trigger an inflammatory response that results in the release of substances that have effects on smooth muscle. Contracture of the smooth muscle in the bronchioles narrows the airways, which diminishes airflow and increases resistance to flow. This is more pronounced on expiration.
Asthma typically develops during childhood, and may be less problematic as individuals grow and have larger airways. It should be noted, however, that it is also possible for asthma—sometimes referred to as reversible airways disease—to develop in middle age or even later.
Asthma is common in the general population, and about a quarter of the people with asthma may experience worsening symptoms related to their work or occupation. If a person becomes exposed and sensitized to a particular substance, even very low doses of that substance can cause symptoms.
The typical chemicals causing allergic reactions are high-molecular-weight agents; but in specific situations, even low-molecular-weight chemicals, as found in some occupational settings, can trigger asthma.
Not all occupational respiratory distress is true IgE-mediated asthma, because irritants can cause bronchospasm in the absence of sensitization. When the World Trade Center collapsed in 2001, 16 percent of people exposed to the alkaline dust continued to have irritant-induced asthma a year later. While a person with asthma may experience occupational worsening, less than 10 percent of workers exposed to known sensitizing substances actually develop asthma.
Outcomes are best when the diagnosis is confirmed early.
In answer to your question, occupational asthma should be considered in your husband’s case, and appropriate investigation should be as comprehensive as is available. This should include assessment of clinical symptoms, confirmation of asthma, skin testing to identify the specific allergens, and blood testing for specific IgE antibody levels.
Perhaps your husband can be moved to a less-dusty area. In addition, improved ventilation of the workplace might help. As a more extensive measure, he might wear personal protective equipment, such as an industrially approved mask. He may even need to be removed from the exposure of the workplace. We realize that this might be problematic, however, since he is in a new job situation, is not well known, and may fear losing his job.
Outcomes are best when the diagnosis is confirmed early, the exposure stopped, and the asthma has not yet become severe. Hyperresponsive airway constriction can be anticipated in 70 percent of patients with occupational asthma. Many companies have occupational health consultants, and such expertise is very helpful in reaching the best outcomes.
Work is an intrinsic and indispensable part of our lives. Our prayer is that there will be a positive outcome, healing, and renewal of daily strength for his tasks.
For more information, we would refer you to an article based on 65 other articles published in peer-reviewed literature.*
* Susan M. Tarlo and Catherine Lemiere, “Occupational Asthma,”
New England Journal of Medicine 370 (2014): 640-649.
